Vearey et al. BMC Public Health (2019) 19:340 https://doi.org/10.1186/s12889-019-6674-8 CORRESPONDENCE Open Access Urban health in Africa: a critical global public health priority Jo Vearey1, Isaac Luginaah2,Ng’weina Francis Magitta3, Dativa J. Shilla4 and Tolu Oni5,6,7* Abstract The African continent is predicted to be home to over half of the expected global population growth between 2015 and 2050, highlighting the importance of addressing population health in Africa for improving public health globally. By 2050, nearly 60% of the population of the continent is expected to be living in urban areas and 35– 40% of children and adolescents globally are projected to be living in Africa. Urgent attention is therefore required to respond to this population growth - particularly in the context of an increasingly urban and young population. To this end, the Research Initiative for Cities Health and Equity in Africa (RICHE Africa) Network aims to support the development of evidence to inform policy and programming to improve urban health across the continent. This paper highlights the importance of action in the African continent for achieving global public health targets. Specifically, we argue that a focus on urban health in Africa is urgently required in order to support progress on the Sustainable Development Goals (SDGs) and other global and regional public health targets, including Universal Health Coverage (UHC), the new Urban Agenda, and the African Union’s Agenda 2063. Action on urban public health in Africa is critical for achieving global public health targets. Four key research and training priorities for improving urban health in Africa, are outlined: (1) increase intersectoral urban health literacy; (2) apply a healthy urban governance and systems approach; (3) develop a participatory and collaborative urban health planning process; and, (4) produce a new generation of urban health scholars and practitioners. We argue that acting on key priorities in urban health is critical for improving health for all and ensuring that we ‘leave no-one behind’ when working to achieve these regional and global agendas to improve health and wellbeing. Keywords: Urban health, Africa, Sustainable development goals, Universal health coverage, Agenda 2063, African union, New urban agenda, Social determinants of urban health The Research Initiative for Cities Health and Equity in development plan [4]. We outline four key research and Africa (RICHE Africa) Network aims to support improve- training priorities for improving urban health in Africa, ments in urban health across the continent. The RICHE that will ensure we ‘leave no-one behind’ when working to Africa Network is made up of both early career and estab- achieve these goals. lished researchers working to support evidence-informed urban public health policy and planning processes in Africa. In this brief paper, we argue that a focus on urban The importance of Africa for global public health health in Africa is required to support progress on the Between 2015 and 2050, over half of the expected global Sustainable Development Goals (SDGs) [1] and other population growth will be in Africa [5], highlighting the global health targets, including efforts to achieve Universal importance of addressing population health on this con- Health Coverage (UHC) [2] the Habitat III New Urban tinent for improving global public health. This increase Agenda (NUA) [3] and the African Union’sAgenda2063 in population growth in Africa is characterised by two distinct features. Firstly, while Africa is currently the * Correspondence: [email protected] least urbanised region of the world, it represents the 5School of Public Health and Family Medicine, University of Cape Town, fastest urbanising continent, with 56% of the population Faculty of Health Sciences, Room 4.41, Entrance 5, Falmouth Building, Cape of the African continent projected to be living in urban Town, South Africa 6Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa areas by 2050 [6]. Secondly, this population growth is Full list of author information is available at the end of the article characterised by a demographic youth bulge with 35– © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Vearey et al. BMC Public Health (2019) 19:340 Page 2 of 4 40% of children and adolescents globally projected to be towards achieving the SDGs in Africa [1]: increase inter- living in Africa by 2050 [7]. These features represent an sectoral urban health literacy [2]; apply a healthy urban opportunity for improving health in the urban setting. governance and systems approach [3]; develop a participa- Urbanisation can result in an “urban advantage” with tory and collaborative urban health planning process; and improved access to healthcare services, education and [4], produce a new generation of urban health scholars employment opportunities, and strengthened social con- and practitioners. nections (compared to their rural counterparts), while the youth demographic dividend represents an oppor- Urban health priorities to achieve global and tunity for economic growth through a growing skilled regional sustainable development goals in Africa workforce. However, this potential is as yet unharnessed Increase intersectoral urban health literacy with increasing intra-urban inequities - evidenced by the To address urban health in Africa we need to improve high proportion of African urban residents, including urban health literacy across multiple sectors and at mul- those migrating into cities, living under conditions of tiple levels, inclusive of public, private and civil society informality, such as unsafe human settlements, and poor actors. Urban health is more than meeting the health access to services that increase vulnerability to poor needs of people living in cities. It is, in itself, an physical, mental and social health - resulting in an approach that recognises the physical, social and eco- “urban penalty” [8]. This penalty is further exacerbated nomic urban environments as determinants of health by high rates of unemployment and high-risk health and of health equity. Driven by a public health and social behaviours among young people. This picture has justice agenda, an urban health approach recognises that become increasingly complex in the African context, cities are inherently unjust spaces typified by inequality with the rise of chronic non-communicable diseases and inequity, and the resultant intra-urban disparities in (NCDs) – such as diabetes, hypertension and heart health. The complexity of African cities needs to be disease - affecting both non-poor and poor alike [9] and understood, by citizens and policymakers alike, from a a rising prevalence of infectious/NCD multimorbidity in Social Determinants of Urban Health (SDUH) [12] per- increasingly younger age groups [10]. spective, that will allow for investigation and identifica- tion of the interlinked multi-level and multi-sectoral A focus on urban health in Africa determinants of urban health (exposures) and the path- Cities are, therefore, critical spaces for action to achieve ways that connect them to health outcomes (systems), the SDGs, UHC, and NUA in Africa and, as a result, glo- with the objective of improving equity in urban health bally: both in terms of the numbers and demographics [8, 10]. Achieving this objective will require partnerships of people living in urban areas now and in the future, with sectors and organisations across public policy, pri- and as a result of increasing levels of urban health vate, and civil society actors, who are well positioned to inequities. Furthermore, the first goal set out by the “move the needle” on these issues. There is therefore a African Union in the Agenda 2063 development plan [4] need for research into the knowledge and attitudes of highlight the need to focus on inclusive growth and sus- key stakeholders across these sectors, in order to inform tainable development, through ensuring a high standard the development of appropriate strategies to improve of living, and quality of life, sound health and well-being. health and SDUH literacy. Such interventions should This aspiration recognizes cities as important hubs of target children and youth in the general population in cultural and economic activities, but also as sources of order to bolster prevention efforts at the individual, exposures that determine health such as the nature of community, and structural levels, and to empower com- the food system and exposure to high sugar and salt munities to apply an SDUH and rights-based lens to foods; the quality of housing and contribution to social better advocate for improved living and working condi- cohesion, contributors to stress and exposure to noise, tions in the city. air, and water pollution [11]. The RICHE Africa Network is working to develop a Apply a healthy urban governance and systems approach common research and training agenda that aims to gener- The